Diabetes on rise among youngsters in India: Expert speaks about the reasons behind the chronic disease and ways to manage it

Does the news about someone in their early 20s dying of a heart attack shock you? It surely does. A youngster in his early 20s suffering from diabetes should shock you as much, if not more. Lately, diabetes has been listed as one of the chronic diseases that a sizable adult population in India is suffering from. The number keeps increasing every day. Healthcare professionals attribute it to an unhealthy lifestyle.

According to the National Family Health Survey of 2019 and 2021, five Indian states: West Bengal, Andhra Pradesh, Uttarakhand, Goa and Tripura showed more than 8 per cent of males aged under 35 having a random blood glucose level of more than 140 milligrams per deciliter (mg/dl). As per the Indian Council of Medical Research (ICMR) 2022 report, India had 95,600 cases of type 1 diabetes in children under the age of 14, with around 15,900 new cases recorded per year in the same age range.

Diabetes has been a primary cause of death in the country's financial capital, Mumbai and the situation is the same across India. In November last year, the Brihanmumbai Municipal Corporation (BMC) said nearly 14 per cent of the deaths in Mumbai in 2021 were attributed to diabetes.

In 2021, the BMC's health department conducted a STEPS (STEP-wise approach to Surveillance) survey devised by World Health Organisation (WHO) that included 5,199 citizens aged between 18-69. The survey revealed that every fifth Mumbaiker had diabetes and the other 15 per cent were pre-diabetic. Approximately, 8 per cent of the surveyed population had both diabetes and hypertension.

Mid-day online spoke to Dr Sneha Kothari, consultant endocrinologist, Global Hospitals, Parel Mumbai. Here Dr Kothari details about the factors leading to diabetes among young adults; the basics of this chronic disease and the necessary measures for diabetic individuals to live a healthy life.

What is diabetes and what are its two types?
Dr Kothari: Diabetes is a chronic disease that develops when your body does not produce enough insulin or does not use it as effectively as it should. Insulin is a hormone that regulates the amount of glucose in the blood.

There are two types of diabetes: type 1 and type 2 diabetes. While type 1 diabetes is a hereditary disorder that frequently manifests early in life, type 2 diabetes is primarily lifestyle-related and develops over time. In type 1 diabetes, the immune system attacks and destroys insulin-producing cells in your pancreas due to which the body fails to produce sufficient insulin. In type 2 diabetes, the body cannot effectively use insulin, leading to high levels of sugar in the blood.

To confirm the diagnosis of diabetes, your doctor will order one or more of the following blood tests:

1. The A1C test is to check your average blood sugar level over the previous three months.
2. Fasting and post-meal blood sugar test
3. Glucose tolerance test
4. For Type1 diabetes, your doctor may also ask you to test for antibodies

Although type 1 diabetes is more common among children and youth, type 2 has also become common now.

What do the readings of your blood sugar test indicate?
Dr Kothari: A fasting blood sugar level of 99 mg/dL or less is considered normal, 100 to 125 mg/dL indicates prediabetes and 126 mg/dL or more implies diabetes. Post-meal blood glucose less than 140mg/dl is normal, 140-199mg/dl is prediabetes and more than 200mg/dl is diabetes.

What are the factors responsible for the rise in diabetes among the young?
Dr Kothari: There are many factors, majorly lifestyle-related, that have exposed the young to a higher risk of type 2 diabetes. These include being physically inactive, having incorrect dietary habits, obesity, alcohol consumption, and smoking. If you are not physically active and are overweight, you are more prone to acquire type 2 diabetes. Excess weight can lead to insulin resistance, which is frequent in persons with type 2 diabetes.

What are some common symptoms one must look out for?
Dr Kothari: The symptoms are determined by your blood sugar level. Some people with type 2 diabetes may not experience any striking symptoms. However, symptoms of type 1 diabetes tend to appear rapidly and are more severe. Some common type 1 and type 2 diabetic symptoms include:

1. Feeling thirstier than usual
2. Urinating often
3. Losing weight without making an effort
4. Feeling exhausted and weak
5. Feeling irritated or experiencing other mood swings
6. Having hazy eyesight
7. Experiencing slow-healing sores

What are the dietary requirements young adults suffering from diabetes must follow?
Dr Kothari: Following the correct diet for diabetic patients is crucial. One must eat a variety of healthy items from all food groups in the right quantity.

This includes:

1. Consuming fruits and vegetables
2. Intake of whole grains such as whole wheat, brown rice, barley, quinoa, and oats
3. Eating protein such as lean meats, chicken, turkey, fish, eggs, nuts, beans, lentils, and tofu
4. Non-fat or low-fat dairy, such as milk, yogurt, and cheese
5. A diabetic person must eat at least three meals a day at regular intervals. This helps in making better use of the insulin your body generates or obtains through medicines.
6. The quantity of the food one eats, however, varies based on the individual's lifestyle.

Which food items and drinks must young adults with diabetes absolutely avoid?
Dr Kothari: Avoid eating high-carb and sugary foods such as candies, cookies, cakes, ice-creams, sweetened cereals and canned fruits with added sugar. White rice, tortillas, bread and pasta made with white flour are best to avoid. Restrain from eating starchy vegetables, such as white potatoes, corn, and sago. Avoid drinks with added sugars, such as juice, regular soda, and energy drinks.

What are the other lifestyle habits that one must adopt for healthy blood sugar levels?
Dr Kothari: Get rid of any excess weight. Exercise regularly at least for 30 minutes as it offers several advantages. Make sure your physical exercise makes you sweat at least five times a day. An active lifestyle helps you control your diabetes by bringing down your blood sugar, lowers your chances of getting heart disease, helps with weight loss and keeps stress levels under control. Besides this, you must stop smoking and watch your alcohol intake. Don't forget to take regular health checkups.

Young adults with diabetes who give up sugar completely often complain of digestion issues. How can such individuals improve digestion?
Dr Kothari: Fibre is an essential component in the overall digestion process. It helps maintain good bowel health and reduces the likelihood of constipation. There are two types of fibre, soluble and insoluble. Each has important health benefits and plays a different role in the body.

Soluble fibre: This type dissolves in water and forms a gel-like substance in your stomach, slowing down digestion. It helps control your blood sugar and cholesterol, which can prevent or manage diabetes complications. Soluble fibre is found in apples, bananas, oats, peas, black beans, lima beans, brussels sprouts, and avocados.

Insoluble fibre: This type does not dissolve in water and typically remains whole as it passes through your stomach. It supports insulin sensitivity and helps keep your bowels healthy. Insoluble fibre is found in whole wheat flour, bran, nuts, seeds, and the skins of many fruits and vegetables.

What are the other health complications that can develop due to diabetes?
Dr Kothari: Diabetes is a multisystem disease which can lead to other health issues like heart disease, chronic kidney disease, nerve damage, blindness, non-healing ulcers, recurrent infection, or stroke. However, with good glycaemic control (blood sugar level), these complications can be avoided.

Can diabetes be cured or reversed?
Dr Kothari: Diabetes cannot be cured, but many techniques can help you keep your glucose levels under control and lower your risk of complications. This can be accomplished by eating the right food, exercising regularly, taking proper treatment and medication and regular follow-ups with a doctor. If you have obesity, your diabetes is more likely to go into remission if you lose a substantial amount of weight like 15kg or so, as quickly and safely as possible following diagnosis. It's important to know that not everyone who loses this much weight will be able to put their diabetes into remission. However, losing 15kg comes with a lot of health benefits, even if it doesn't lead to remission. Research shows that getting support to lose just 5 per cent of your body weight can have huge benefits for your health like reduced medications, better blood sugar levels, and a lower risk of other health complications.

Also Read: Quashing five most commonly mistaken myths about diabetes